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General NPI Number Information
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NPI Number | 1255855185
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Entity Type | Organization
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Legal Business Name | LILY BOLLINGER PSYD LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 EVES DR STE 146
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City | MARLTON
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State | NJ
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Zip | 08053-3125
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Country | US
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Telephone | 856-701-6446
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Fax | 856-596-7299
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Provider Business Mailing Address
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Address Line | 1 EVES DR STE 146
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City | MARLTON
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State | NJ
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Zip | 08053-3125
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Country | US
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Telephone | 856-701-6446
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Fax | 856-596-7299
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LILY BOLLINGER
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Credential | PSYD
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Telephone | 856-701-6446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | NJ4003
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License Number State | NJ
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